Cold in Death
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But carefully monitored, a patient can remain in this cold stasis, undamaged, for hours. They brush snow from his pasty, frozen face. Then one snakes down through the forest to the nearest cabin. The others, left in the pre-dawn darkness, huddle against him as silence closes around them. For a moment, the woman imagines she can hear the scurrying, breathing, snoring of a world of creatures that have taken cover this frigid night beneath the thick quilt of snow.
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Usually such victims can be straightened from their tortured fetal positions. They attach heart-monitor electrodes to his chest and insert a low-temperature electronic thermometer into his rectum. Digital readings flash: 24 beats per minute and a core temperature of The doctor shakes his head.
In fact, many hypothermia victims die each year in the process of being rescued. In , 16 shipwrecked Danish fishermen were hauled to safety after an hour and a half in the frigid North Sea. They then walked across the deck of the rescue ship, stepped below for a hot drink, and dropped dead, all 16 of them.
The doctor rapidly issues orders to his staff: intravenous administration of warm saline, the bag first heated in the microwave to degrees. Elevating the core temperature of an average-size male one degree requires adding about 60 kilocalories of heat. A kilocalorie is the amount of heat needed to raise the temperature of one liter of water one degree Celsius.
Since a quart of hot soup at degrees offers about 30 kilocalories, the patient curled on the table would need to consume 40 quarts of chicken broth to push his core temperature up to normal. Even the warm saline, infused directly into his blood, will add only 30 kilocalories. But such machines are rarely available outside major urban hospitals.
Here, without such equipment, the doctor must rely on other options. Warm fluid begins to flow from a suspended bag, washing through his abdomen, and draining out through another catheter placed in another incision. Prosaically, this lavage operates much like a car radiator in reverse: The solution warms the internal organs, and the warm blood in the organs is then pumped by the heart throughout the body.
His pulse edges up.
Built-in cold protection
But even so the jagged line of his heartbeat flashing across the EKG screen shows the curious dip known as a J wave, common to hypothermia patients. For another hour, nurses and EMTs hover around the edges of the table where the patient lies centered in a warm pool of light, as if offered up to the sun god. They check his heart. They check the heat of the mattress beneath him. They whisper to one another about the foolishness of having gone out alone tonight. And slowly the patient responds.
Hypothermia - Wikipedia
Another liter of saline is added to the IV. Fluid lost through perspiration and urination has reduced his blood volume. But every 15 or 20 minutes, his temperature rises another degree. The immediate danger of cardiac fibrillation lessens, as the heart and thinning blood warms. Frostbite could still cost him fingers or an earlobe. But he appears to have beaten back the worst of the frigidity. For the next half hour, an EMT quietly calls the readouts of the thermometer, a mantra that marks the progress of this cold-blooded proto-organism toward a state of warmer, higher consciousness.
From somewhere far away in the immense, cold darkness, you hear a faint, insistent hum. Quickly it mushrooms into a ball of sound, like a planet rushing toward you, and then it becomes a stream of words. You sense heat and light playing against your eyelids, but beneath their warm dance a chill wells up inside you from the sunless ocean bottoms and the farthest depths of space.
You are too tired even to shiver. You want only to sleep. You force open your eyes.
Lights glare overhead. Around the lights faces hover atop uniformed bodies. You try to nod. Your neck muscles feel rusted shut, unused for years. They respond to your command with only a slight twitch. You remember the moon rising over the spiky ridgetop and skiing up toward it, toward someplace warm beneath the frozen moon.
After that, nothing—only that immense coldness lodged inside you. All you can feel is throbbing discomfort everywhere. Glancing down to where the pain is most biting, you notice blisters filled with clear fluid dotting your fingers, once gloveless in the snow.
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During the long, cold hours the tissue froze and ice crystals formed in the tiny spaces between your cells, sucking water from them, blocking the blood supply. You stare at them absently. We expect that the blisters will break in a week or so, and the tissue should revive after that. If not, you know that your fingers will eventually turn black, the color of bloodless, dead tissue.
And then they will be amputated. But worry slips from you as another wave of exhaustion sweeps in.
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Slowly you drift off, dreaming of warmth, of tropical ocean wavelets breaking across your chest, of warm sand beneath you. Hours later, still logy and numb, you surface, as if from deep under water. A warm tide seems to be flooding your midsection. You follow the tubes to the bag that hangs suspended beneath the electric light. And with a lurch that would be a sob if you could make a sound, you begin to understand: The bag contains all that you had so nearly lost. These people huddled around you have brought you sunlight and warmth, things you once so cavalierly dismissed as constant, available, yours, summoned by the simple twisting of a knob or tossing on of a layer.
Heat exists only where matter exists, where particles can vibrate and jump. In the infinite winter of space, heat is tiny; it is the cold that is huge. Someone speaks. Your eyes move from bright lights to shadowy forms in the dim outer reaches of the room. Left untreated, hypothermia can lead to complete failure of the heart, and eventually death, according to the Mayo Clinic.
Yet people's bodies are pretty hardy in the cold, as we have two built-in mechanisms to protect us from frigid conditions.
http://gatsby-estates.co.uk/an-introduction-to-applied-and-environmental.php As soon as that bitter air hits your face, your body will try to insulate itself by moving blood away from the skin and outer extremities, such as fingers and toes, and toward its core. This process is called vasoconstriction, and it helps limit the amount of heat you lose to the environment, Castellani said.
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The second response from your body is shivering , which produces heat and helps raise body temperature. Although extreme conditions are often needed to induce hypothermia in a healthy person, frostbite is more common in less severe weather. Your fingers and toes are more prone to frostbite, because those areas will have reduced blood flow in cold temperatures, as your body tries to keep its core warm.
Even though your feet are usually protected by shoes, toe temperatures can get very low, and if you sweat, the wetness will draw even more heat out of the area. Since frostbite is brought on by freezing, you can't get frostbite if the air temperature is above 32 F 0 C. How long it takes you to develop frostbite will depend on the conditions.
For example, if it's 0 F minus 18 C with a wind chill of minus 19 F minus 28 C , you could be frostbitten in 30 minutes; but if it's minus 15 F minus 26 C with a wind chill of minus 55 minus 48 C , you could get frostbite in as few as 5 minutes, according to the National Weather Service.
Despite these risks, "human beings can go out in very extreme cold environments and do very well," Castellani said. People climb mountains, trek in the Arctic and swim the English Channel, which has very low water temperatures. Still, you need to be properly dressed to weather the cold conditions. Glatter recommended that people wear at least three layers — a wicking layer that wicks moisture away from the skin, an insulating layer and a protective outer layer to protect against the wind and other elements.
In addition, Glatter recommended that people wear thick, insulated boots, since the feet and toes are at high risker risk for frostbite. Hypothermia is also associated with worse outcomes in people with sepsis. In urban areas, hypothermia frequently occurs with chronic cold exposure, such as in cases of homelessness, as well as with immersion accidents involving drugs, alcohol or mental illness. Alcohol consumption increases the risk of hypothermia in two ways: vasodilation and temperature controlling systems in the brain.
Rising fuel bills have increased the numbers who have difficulty paying for adequate heating in the UK. Some pensioners and disabled people are at risk because they do not work and cannot easily leave their homes. Hypothermia continues to be a major limitation to swimming or diving in cold water. Other factors predisposing to immersion hypothermia include dehydration , inadequate rewarming between repetitive dives , starting a dive while wearing cold, wet dry suit undergarments, sweating with work, inadequate thermal insulation for example, thin dry suit undergarment , and poor physical conditioning.